title: Risks associated with the transfusion of various blood products in aortic valve replacement.
abstract: BACKGROUND
  Patients undergoing cardiac operations often require transfusions of red blood cells, plasma, and platelets. From a statistical point of view, there is a significant collinearity between the components, but they differ in indications for use and composition. This study explores the relationship between the transfusion of different blood components and long-term mortality in patients undergoing aortic valve replacement alone or combined with revascularization.
  
  
  METHODS
  A retrospective single-center study was performed including 1,311 patients undergoing aortic valve replacement. Patients who received more than 7 units of red blood cells, those who died early (7 days), and emergency cases were excluded. Patients were monitored for up to 9.5 years. A broad selection of potential risk factors were analyzed using Cox proportional hazards regression, where transfusion of red blood cells, plasma, and platelets were forced to remain in the model.
  
  
  RESULTS
  The transfusion of red blood cells was not associated with decreased long-term survival (hazard ratio [HR], 1.01; p = 0.520) nor was the transfusion of platelets (HR, 0.946; p = 0.124); however, the transfusion of plasma was (HR, 1.041; p < 0.001). All HRs are per unit of blood product transfused. No increased risk was found for patients undergoing a combined procedure.
  
  
  CONCLUSIONS
  No significant risk for long-term mortality was associated with transfusion of red blood cells during the study period. However, the transfusion of plasma was associated with increased mortality.
authors.affiliation: Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden. henrik.bjursten@med.lu.se
authors.forename: Henrik
authors.initials: H
authors.lastname: Bjursten
authors.forename: Faleh
authors.initials: F
authors.lastname: Al-Rashidi
authors.forename: Alain
authors.initials: A
authors.lastname: Dardashti
authors.forename: Björn
authors.initials: B
authors.lastname: Brondén
authors.forename: Lars
authors.initials: L
authors.lastname: Algotsson
authors.forename: Per
authors.initials: P
authors.lastname: Ederoth
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001803:Blood Transfusion / Q000401:mortality*; D001026:Coronary Artery Bypass; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction
keywords: 18; ALT; AVR; BMI; C-reactive protein; CABG; CCS; CI; COPD; CPB; CRP; Canadian Cardiovascular Society; HR; IABP; ICU; LVEF; MDRD; Modified Diet in Renal Disease; NYHA; New York Heart Association; PCI; PLA; PVD; RBC; RIFLE; TRALI; TRC; alanine aminotransferase; aortic valve replacement; body mass index; cardiopulmonary bypass; chronic obstructive pulmonary disease; confidence interval; coronary artery bypass grafting; eGFR; estimated glomerular filtration rate; hazard ratio; intensive care unit; intraaortic balloon pump; left ventricular ejection fraction; percutaneous coronary intervention; peripheral vascular disease; plasma; platelets; red blood cell; risk-injury-failure-loss-end stage; transfusion-related acute lung injury